ELIZABETH WRIGHT. M.D.
KNOW THE PATIENT.
“A case well taken is half cured.” one of the masters said. For a good homoeopathic prescription a good deal of information is essential which is not needed in ordinary medicine. The homoeopath must know his patient, spiritually, emotionally, mentally, physically and sociologically. He must give as much time as he needs to acquiring this knowledging. He must not prescribe anything but Placebo, in a chronic case, until be has it. In an acute case he must know these same factors in so far as they affect the acute condition. Let us suppose that a new patient comes into the office of a homoeopath. What is the procedure?.
1. The physician must be receptive, like a photographic plate ready to receive the image of the patient. He must clear his mind of other preoccupations and of previous opinions about the patient. He must be tranquil, cordial, and after the first greeting and question, “What brings you to see me?” or “Tell me what it is that troubles you.” he must be silent.
2. The physician must allow the patient to tell his own story in his own way. Questions or interruptions of any sort derail the patient at this stage, and may cause the doctor to lose essential information.
3. The physician must observe from the moment the patients enters. The office should be so arranged that the light falls not he patient. The main points to be noted are: (1) The personality of the patient. (2) His apparent state of mind both in himself and in relation to the doctor (whether depressed, shy, suspicious, secretive, afraid, ashamed, etc.). (3) His apparent physical status (signs of disease in gait, complexion, difficulty in breathing etc.). (4) Traits of character as shown in dress, cleanliness, neatness, pride, etc.
4. The physician must record every item which seems to him important, in the words of the patient, both in what the patient says and in what he himself observed, in a column at the left of his paper, leaving at least an inch blank between the items to be subsequently filled in as the patient reverts to that subject or, later, when the physician questions about it. He may prefer to put facts pertaining to history on one sheet or in one column, those pertaining to actual physical symptoms in another, and mentals in a third, but this requires experience and adeptness. It is safer for the beginner to list them all as they come and sort them later in the working out of the case.
5. When the patient has come to a full stop the physician may say, “what else?” and by waiting elicit much more and often much more valuable information. If the patient is reticent or gives only brief objective data, and the physician is unable to persuade him to give more, this passive method may have to be abandoned in favour of active questioning. The object is to brain the patient dry of what he knows of himself. If the patient is loquacious, time may necessitate the prevention of irrelevancies and the utmost tact is needed to keep him on the main track and yet not lose important side lights.
6. When the patient is through with his story a few remarks by the physician may be in order as to the aid that can be given through our remedies and the necessity for special knowledge of the patient as a whole and many details ordinarily overlooked. This pleases the patient and insures cooperation in answering the often rather intimate questions which must follows.
7. The data needed for an ordinary medical history may hardly have been touched on up to this point and should not be inquired into even yet. If by time the consultation period is over, if the patient is not in acute pain or distress, or has not come from a long distance, a subsequent appointment should be made for the next day if possible, and the patient should be definitely told that the physician must do a complete physical examination and the necessary routine laboratory tests at the next visit. Instructions for bringing a 24-hour urine specimen should then he given. The makes the patient realise that in addition to the interest to all details of the case the physician is going to be thoroughly scientific.
8. The physician should now take up each item that he has noted on paper and get the patient to tell him more about it. When the patient has exhausted all that he can tell about each item the physician should bring out the “modalities,” if for instance, the item is pain in the stomach and the patient volunteers that it is burning and has not relation to meals and not radiation, the physician must find what aggravates or ameliorates it, what time it occurs, its concomitants, its relation to mental states, if any, etc. When each item has been so modified and filled in, the physician must run through the list and see which of the possible mentals, generals, particulars, and modalities have not been mentioned and question the patient about each of these.
9. All question that the physician asks must be so put that the patient cannot reply with a simply “Yes” or “No” but must think before answering. The physician must be careful never to suggest and answer by the form of his question and must guard against questioning for the symptoms of a particular remedy which may have come to his mind. If he has seen a fairly definite remedy picture in the patients story and wished to clinch it he must take special care not to lead the patient into the answer he desires, and may even suggest the opposite, and watch the reaction.
10. When the physician has covered the fields outlined above in detail, according to a systematic outline, which the novice should have before him during the interview and which the master knows by heart ( we append a suggested one), he must make sure that he has questioned the patient on every system and function, otherwise some important detail will be missed which might prove a key note suggesting the study of one or more remedies.
11. The mental symptoms and characteristics of the patient (which, as will be brought out in a later lecture, are the most important if strongly marked) should usually be elicited last when the patients confidence has been more fully gained. Especial tact and insight on the part of the physician are needed to evaluate the emotional causes of disease, for instance, few patients would know that ailments from mortification might be the most important symptom in their case, or that suppression of sex needs or anger might rank as a leading cause in their illness.
12. At the close of the interview the patient must be made to feel that the physician is deeply interested in his case, that he will take the hours needed to thoroughly study up (to repertorize) the case, and that the special method of Homoeopathy can bring not only relief but also a fundamental improvement in the whole constitution which will tend to ward off subsequent illness and increase the powers and well being of the patient.
A thorough physical examination and the routine laboratory work, or any extra tests suggested by the history must be done on every new patient and at least yearly on old patients, and the patients instructed as to why they should not use other drugs during homoeopathic treatment, what the dangers of suppression are, when they should report back, and what they may expect as the immediate results of the treatment.
One other point may be valuable in knowing the patient and that is to get the version of the immediate family and close friends. This is sometimes dangerous, as nervous patients hate to know that they are being talked over, but the wise physician can take much contradictory evidence and arrive at a more just and sympathetic evaluation of the case.
By this time the physician should have a remarkably accurate picture of the patient in all his phases, subjective, objective, pathological. From this totality of symptoms he can, by correctly evaluating the symptoms as we will show in a subsequent lecture, derive a true image of the patient and the remedy.
OUTLINE FOR TAKING THE TEST.
I. The patients story.
II. Modalities as applied to each of the above symptoms in the following order.
b. Prodrome, onset. pace, sequence, duration.
c. Character, location, laterality, extension and radiation of pain or sensation.
d. Concomitants and alternations.
e. Aggravation or amelioration.
1. Time (hour, day, night, before or after midnight); periodicity; seasons; moon phases.
2. Temperature and weather; chilly or warm blooded usually, chilly or warm blooded in present illness; wet, dry, cold, or hot weather changes; storm or thunder-storm (before, during or after); hot sun, wind, fog, snow; open air, warm room, changes from one to other, stuffy or crowded places, drafts, warmth of bed, heat of stove, uncovering.
3. Bathing (hot, cold or sea), local applications (hot, cold, wet or dry).
4. Rest or motion (slow or rapid, ascending or descending, turning in bed, exertion, walking, on first motion, after moving awhile, while moving, after moving), car and seasickness.
5. Position: Standing, sitting, (Knees crossed, rising from sitting), stooping (rising from stooping), lying (on painful side, back, right or left side, abdomen, head high or low, rising from lying), leaning head backward, forward, side-wise, closing or opening eyes, any unusual position such as knee-chest.
6. External stimuli: Touch, hard or light, pressure, rubbing, constriction (clothing etc.), jar, riding, stepping, light, noise, music, conversation, odors.
7. Eating: In general (before, during after,m hot or cold food or drink), swallowing (solids, liquids, empty), acids, fats, salt, salty food, starches, sugar and sweets; green vegetables, milk, eggs, meat, fish, oysters, onions, beer, liquor, wine, coffee, tea, tobacco, drugs, etc.
8. Thirst, quantity, frequency, hot, cool or iced, sours, bitters, etc.
9. Sleep: In general (before, during, on falling asleep, in first sleep, after, on waking)
10. Menses (before, during, after, or suppressed)
11. Sweat: Hot or cold, foot-sweat, partial or suppressed.
12. Other discharges:Bleeding, coryza, diarrhoea, vomitus, urine, emissions, leucorrhoea, etc., suppression of same.
13. Coition, continence, masturbation, etc.
14. Emotions: Anger, grief, mortification, fear; shock, consolation, apprehension of crowds, anticipation, suppression of same.
f. Strange, rare and peculiar symptoms.
III. The patient as a whole: MENTAL GENERALS (to be studied last for convenience), Physical Generals.
a. The constitutional type of the patient (endocrinology-co- homoeopathic correspondences, lack or excess of vital heat, lack of reaction, sensitiveness, etc.
b. Ailments from emotions (see also mental general); suppressions (emotions: discharges such as menses, sweat, leucorrhoea, catarrh, diarrhoea, etc.; eruptions; diseases such as malaria, rheumatic fever, exanthem, syphilis, gonorrhea, etc.; of pathology such as haemorrhoids, fistulae, ulcers, tonsils, tumors, other surgical conditions, etc.); from exposure to cold, wet, hot sun, etc.; from mechanical conditions such as overeating, injury, etc.
c. Menses, date establishment, regularity (early or late), duration, color, consistency, odor, amount, clots, membrane, pain (modalities of), concomitants, aggravation or amelioration before, during or after (both physically and mentally), menopause (symptoms of).
d. Other discharges, (see II e. 12) cause colour, consistency, odor, acrid, or bland, symptoms from suppression of, symptoms alternating with, hot or cold, partial discharges as of sweat, laterality, better or worse from discharges (before, during or after).
e. Sleep, better or worse from, position in, aggravation after, difficulty in getting to sleep, waking frequently or early, at what hour, somnambulism, talking in sleep, dreams (see Mentals), restless during.
f. Restlessness, prostration, weakness, trembling, chill, fever etc.
g. Aggravations and ameliorations applying to patient as a whole as under II. e. 1 to 14.
h. Objective symptoms such as redness of orifices, superfluous hair, applying to patient as a whole.
i. Pathology which applied to patient as a whole, such as tendency to tumors, wens, cysts, polypus, warts, moles, individual and family tendency to certain diseases or weakness of specific organs or tissues (also related to a above and to physical examination), frequent of catching cold.
a. Will: Loves, hates and emotions (suicidal, loathing of life); lasciviousness, revulsion to sex, sexual perversions: fear; greed, eating, money, emotionality, smoking, drinking, drugs; drams; homicidal tendencies, desire or aversion to company, family friends; jealousy, suspicion, obstinacy, contrariness, depression, loquacity, weeping laughing, impatience, conscientiousness.
b. Understanding: Delusions, delirium, hallucinations, mental confusion, loss of time sense.
c. Intellect: Memory, concentration, mistakes in writing and speaking.
IV. Quick review of condition of every system and organ beginning with head and following order of Kent;s Repertory.
V. Past history of patient in seven year periods.
VI. Family history.
VII. Physical examination and laboratory tests.